Management and treatment of osteoporosis in patients receiving long-term glucocorticoid treatment: Current status of adherence to clinical guidelines and related factors

Abstract

Objective The aim of this study was to evaluate the adherence of guidelines for the management and treatment of glucocorticoid-induced osteoporosis, and to investigate whether it is associated with factors such as age, gender, glucocorticoid dose, physician specialty, and size of facility. Methods This was a cross-sectional study utilizing administrative data from a database of health insurance claims (2004-2007); 2,368 patients who received glucocorticoid treatment for_90 days were extracted. The guideline adherence was determined by evaluations based on glucocorticoid prescription dose, prescription of anti-osteoporosis drugs, and whether or not bone mineral density was measured. Results Overall proportion of guideline adherence was 23.3%. In cases in which the equivalent dose of prednisolone was<5 mg/d and_5 mg/d, the adherence was 8.3% and 30.5% respectively. Factors correlating with low adherence included young age, male gender, and lower glucocorticoid doses. Surgery and otolaryngology specialties had lower adherence than internal medicine. Smaller clinical facilities had lower adherence than larger facilities. Conclusion The adherence of guidelines for the management and treatment of glucocorticoid-i nduced osteoporosis is still low, and improvements in treatment quality can be expected through education of patient groups and medical care providers with large deviations from the guidelines. © 2011 The Japanese Society of Internal Medicine.